J.Jpn. Surg. Soc.. 79(12): 1505-1517, 1978

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Original article

CHRONIC ARTERIAL INSUFFICIENCY OF THE LOWER LIMBS IN THE JAPANESE PEOPLE
1. THE CHANGE OF THE BLOOD VESSEL CONFIGURATION AND ITS EFFECTS TO THE CIRCULATION OF THE LOWER LIMBS IN THE JAPANESE STYLE SITTING POSTURE

For these 300 years, we Japanese have kept the characteristic sitting posture, named " Seiza", which have never been seen in other Asian area, bending extremely both knee joints and loading the whole body weight on the legs and feet. This particular habitual life has obliged us to be concerned about the study of the flexion and extension of the joint for the femoropopliteal occlusive disease.
Materials and methods : Various vascular insufficiencies of the limbs (25 cases) such as thromboangitis obliterans, arteriosclerosis obliterans, migratory phlebitis, deep vein throbmsis, and varix have become the object of this study.
Results : In the absence of the arterial occlusion, the plethysmogram shows less amplitude during the Japanese style sitting posture, suggesting the decrease of the digital blood flow. Moreover, the angiographic studies have been done in the Japanese style sitting posture. These angiograms show the common features of the arterial configuration in all cases : 1 . the superficial femoral artery deviates together with the adductor canal upwards 2. The popliteal artery is depressed downwards and kinked at the outlet of the adductor canal. Its midportion, threatened to the extreme hyperflexion shows the kinking or coiling with localized narrowing. 3. The anterior tibial artery, free from the compression, maintains the blood flow of the leg. 4. The posterior tibial artery is opressed and obstructed by the body weight and shows the diffuse narrowing.
Conclusion : The data above mentioned about the Japanese style sitting posture "Seiza" obviously take the important part of the disease process, especially may bring the acute thrombotic occlusion of the vascular lumen if the patients are obliged to keep this posture. Repeated trauma by the extrinsic compression to the vascular wall in particular portion in this posture, are another important problems, which may have the part of the possible causes of the successive occurrences of the intimal fibrosis.

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